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Indiana rates for HCPCS L5658

Addition To Lower Extremity Socket Insert Above Knee (Kemblo Pelite Aliplast Plastazote Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$260.79 / $260.79 / $547.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$215.99 / $260.79 / $271.22
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$432.90 / $490.44 / $547.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.11 / $266.11 / $367.23
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$370.94 / $575.38 / $767.17
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$465.78 / $602.78 / $739.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.26 / $366.26 / $547.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.37 / $366.26 / $509.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.13 / $273.38 / $362.40